This is the area to configure your profile. The information gathered will be used to interface with clients and management of Short-Term-Benefits. Ensuring that correct information is captured will help to receive proper credit for referred clients.
Personal Information
First Name:  
Last Name:  
Social Security Number:      (format ###-##-####)
Florida License Number:      (Needed if conducting business in Florida)
Access Control Information
Username:      (5-20 characters)
Password:      (8 to 12 characters)
Office Information
Address:  
City:  
State:  
Zip:  
Contact Information
Office Phone:  
Cell Phone:  
Email:  
Represented Products
Central United\Manhattan:  
TPA Processing:  

Who do you represent?
Agency:  
Agency POC:  

Status:   ACTIVE
Agent ID: A 2022-01-27 09:24:16
Record Established: 01/27/2022
Last Activity: 01/27/2022
 
© 2021, Apex Insurance Group, All Rights Reserved